Amrinone as an Inotrope in Managing Hypermetabolic Surgical Stress

Dobutamine is the standard inotrope used as cardiac support for hyperdynamic hypermetabolic patients following acute surgical stress. Amrinone has been utilized in medical patients with heart failure, but its use in hyperdynamic patients to our knowledge has never been reported. We now report the results of a trial of amrinone versus dobutamine in this setting. Over a 3-month period, we compared 28 trials of dobutamine and 27 trials of amrinone in 47 patients. Attempts were made to achieve non-flow-dependent oxygen consumption. Values are expressed as pre/post inotrope. Student's two-tailed t test was used for evaluation. [table: see text] Patients treated initially with dobutamine were slightly younger (mean, 46 vs. 57 years). They required slightly higher doses of dobutamine (mean, 12.9 vs. 12.2 micrograms/kg/min) and a slightly longer treatment period (mean, 11.3 vs. 9.8 hours) to achieve the desired effect. Of the 47 trials with dobutamine, six (13%) failed to achieve non-flow-dependent oxygen consumption. All then responded somewhat to amrinone. The failure rate for amrinone was 10%. No patient developed hypotension when treated with either drug. Amrinone is an effective inotrope useful in the cardiovascular support of hyperdynamic patients following surgical stress. Hypotension is not a problem with adequate intravascular volume loading. It should become part of the standard drug regimen in the surgical ICU.